Review of theological and doctrinal considerations of three religions impacting digital replantation decision making

This paper attempts to review the issue of amputation from a religious and eschatological belief system view. Interpretations are made by respected leaders and represent their own interpretation of this complicated issue and in no means are a generalization of any religion as a whole. A review of religious doctrine was done by an academic religion department and again represents individual interpretation of these works. The purpose of this review is to enlighten hand surgeons about the role of culture and religion in amputation.

The eschatological impact has deep roots in the Jewish religion. An ongoing debate amongst Jewish religious circles is the requirement to be whole at the time of death. Some authorities believe that a person who donates or looses an organ goes into the world to come without that organ [Rabbi Reuven Bulka, interviewed June 2009, Ottawa, ON, Canada (personal communication)]. It is this belief that drives the Zaka organization, a group known for collecting human remains with meticulous detail after a terrorist attack to provide a proper Jewish burial [3]. Interestingly, there is a ritualistic Jewish procedure for which body parts can be buried so the individual may be reunited with the body part in the afterlife.

In Islamic tradition respect and dignity for the dead body is important; therefore, Islam opposes autopsies except in cases where it is legally required. Even then, the physician is admonished to make the smallest incisions possible. Organ donation is considered legitimate and righteous in the Islamic faith [1]. In some understandings or interpretation of Islamic law, amputation is a prescribed penalty for particular criminal actions. Robert Gleave [2] explains that in these cases, the amputation is not the punishment, but rather the punishment is living with the deformity.

In order to be a Catholic priest, you must have your hands without deformity to participate in mass, particularly the ritual of transubstantiation in which the host is believed to become the body of Christ and the wine is believed to transform into the blood of Christ as the priest holds them up [5]. During the ordination of a Catholic priest, the hands hold special and specific ritualistic relevance. During this ritual the priest’s hands are anointed, and during the ordination of a bishop, the hands are bound together. Further, in 1985, the 41-member church council of the American Lutheran Church barred those who suffered from significant physical or mental handicaps from ordained ministry [4]. The council stated at the time of this decision that “Pastors are expected to be sufficiently able-bodied, ambulatory and mobile.” This is also true for Catholics, as priests are expected to be fully capable of serving the people and not be a burden in any way.

How religion plays a role in a patient’s choices and attitudes towards amputation and other medical issues that cause a physical deformity is dependent on what religious faith group they belong to, how that specific faith community is interpreting the religion, as well as the particular knowledge and understanding of the individual. Nevertheless, there are important commonalities found in the three monotheistic systems. Within Judaism, Islam, and Christianity, a religiously inspired concern and care for the physical body can be found. It is seen as sacrosanct, a holy vessel deserving of respect and dignity and everyone shares the desire to be physically whole. There are important areas of differentiation as well. An Islamic tradition that occurs in some areas of the world, of creating or viewing physical deformity as a punishment for a criminal offense, ought not to be dismissed in a diverse and multicultural society. Patients originating from these areas may have important concerns over how their physical deformity might be understood in their communities. An emphasis on God’s ability to heal in Islam and Christianity may motivate a patient to proceed with a replant than is unlikely to have a favorable outcome in the eyes of the surgeon.

Furthermore, the effect an individual’s religion has on medical choices is varied within religious groups. There are no certain responses that one can expect from one particular faith or another. What one believes religiously will affect one’s views and responses to specific medical options. What is most important to note is that in all three religions investigated, the preservation of life is held in priority to all other physical considerations.